title: Using SEER data to quantify effects of low income neighborhoods on cause specific survival of skin melanoma.
abstract: BACKGROUND
  This study used receiver operating characteristic (ROC) curves to screen Surveillance, Epidemiology and End Results (SEER) skin melanoma data to identify and quantify the effects of socioeconomic factors on cause specific survival.
  
  
  METHODS
  'SEER cause-specific death classification' was used as the outcome variable. The area under the ROC curve was to select best pretreatment predictors for further multivariate analysis with socioeconomic factors. Race and other socioeconomic factors including rural-urban residence, county level % college graduate and county level family income were used as predictors. Univariate and multivariate analyses were performed to identify and quantify the independent socioeconomic predictors.
  
  
  RESULTS
  This study included 49,666 patients. The mean follow up time (SD) was 59.4 (17.1) months. SEER staging (ROC area of 0.80) was the most predictive factor. Race, lower county family income, rural residence, and lower county education attainment were significant univariates, but rural residence was not significant under multivariate analysis. Living in poor neighborhoods was associated with a 2-4% disadvantage in actuarial cause specific survival.
  
  
  CONCLUSIONS
  Racial and socioeconomic factors have a significant impact on the survival of melanoma patients. This generates the hypothesis that ensuring access to cancer care may eliminate these outcome disparities.
authors.affiliation: cheung.r100@gmail.com
authors.forename: Min Rex
authors.initials: MR
authors.lastname: Cheung
mesh_terms: D000328:Adult; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012424:Rural Population / Q000706:statistics & numerical data; D018426:SEER Program; D012878:Skin Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D012923:Social Class; D012959:Socioeconomic Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D055815:Young Adult